New laser finds niche in superior tattoo removal treatment

Boston - The PicoSure laser (Cynosure) is proving to be a major breakthrough in tattoo removal by helping to clear notoriously stubborn colors quicker and more effectively then other laser technologies, according to an expert.

“The gold standard in tattoo removal is changing very quickly, particularly since the advent of the PicoSure laser,” says Roy G. Geronemus, M.D., clinical professor of the department of dermatology at NYU Langone Medical Center and director of the Laser & Skin Surgery Center of New York. He spoke recently at the annual meeting of the American Society for Laser Medicine and Surgery.

“Picosecond technology can significantly impact the treatment of tattoos, particularly when targeting darker colored blue and green inks, which used to be some of the hardest colors to treat. Black colors can also be cleared much faster with this laser, further saving valuable time for both physician and patient,” he says.

Technological advancement

Powered by revolutionary picosecond technology, the novel picosecond 755 nm alexandrite laser delivers ultra-short pulse bursts of energy to the skin in trillionths of a second, he says. The picosecond pulse duration is 100 times shorter than nanosecond technology, allowing the clinician to perform more effective treatments and achieve a superior clearance of tattoos, in fewer treatments and using less fluence.

Using patented pressure wave technology, PicoSure’s ultra-short pulse duration goes beyond the photothermal action of nanosecond technology by creating an intense photomechanical impact, fragmenting the targeted tattoo color into tiny ink particles, which are then more easily eliminated via phagocytosis.

Though Q-switched nanosecond lasers are widely viewed as effective, safe and reliable aesthetic tools in removing tattoos of varying colors, Dr. Geronemus says PicoSure treatments are easier, faster and more effective for tattoo removal.

Clinical evidence

Dr. Geronemus and colleagues recently conducted a 22-patient clinical trial with the PicoSure laser, treating a total of 24 tattoos over a two-week period, including 11 previously untreated, multicolored tattoos and 13 that were recalcitrant to previous laser treatments. The mean age of the tattoos treated exceeded 10 years.

Results demonstrated a greater than 80 percent overall tattoo clearance, and on average, a 94 percent clearance was achieved for blue and green ink after only one or two treatments. None of the treated areas showed any pigmentary changes or scarring, he says.

“Previously, the removal of green and blue tattoo ink was extremely difficult, if not impossible with other laser devices and technologies,” Dr. Geronemus says. “The PicoSure laser allows us to remove these colors more rapidly in approximately half of the time compared to other laser systems.”

In the study, the clearance of targeted ink was assessed from baseline using standardized photographs and a grading scale where 0 = less than 25 percent, 1 = 26 to 50 percent, 2 = 51 to 75 percent, and 3 = greater than 75 percent clearance.

All tattoos contained black ink, while green, blue, red and yellow ink was present in 16, 12, 11 and nine tattoos, respectively. Other tattoo colors included pink, purple, orange and white. According to Dr. Geronemus, the PicoSure could remove some colors more effectively than others, with mean clearance scores showing a 3 for green, 2.75 for blue, 1.89 for black, and 0.67 for red ink.

Comparatively speaking

Most green and blue tattoos can be completely removed in as few as one to three treatments, Dr. Geronemus says, whereas the same tattoo would typically require many more treatments using other lasers and technologies. Except for red ink, the PicoSure also can reduce the number of treatments required to clear other colors however, the reduction in the number of treatments depends on the type of inks used in a given tattoo.

“The PicoSure is very effective in clearing green and blue pigment and quick in lightening other tattoo colors; however, it is less optimal for the removal of red ink,” he says. “Here, Q-switched lasers such as the 532 nm Nd:YAG laser still remain the better choice, underscoring their importance in tattoo removal.”

Recovery time following tattoo removal treatment in part depends on the color of the ink and the skin color of the patient treated. Compared to any of the other Q-switched lasers currently used for tattoo removal, however, Dr. Geronemus says the recovery time following treatment with the PicoSure is faster, typically about seven days, due to less collateral injury of surrounding tissues.

Though clinicians must always proceed with caution, Dr. Geronemus says postinflammatory hyperpigmentation is less of an issue with the picosecond laser, including those patients of darker skin types.

“Picosecond technology is a new and exciting development in aesthetic lasers. The PicoSure laser may surpass the popularity of Q-switched lasers and, in my opinion, it is the standard of care for the removal of particularly difficult-to-treat colors, such as blue and green,” Dr. Geronemus says.

Disclosures: Dr. Geronemus reports no relevant financial interests.